140. Have you sat down and developed a model
that you know is the approach, that if you do not drag them in,
if you do not have shared objectives from day one, it is not going
to work?
(Ms Casey) In the rough sleeping world obviously we
rely very heavily on local authorities and ourselves in the unit
to work with consortia of people who are brought together to agree
whether they want to ensure that people do not have to sleep rough
in their area or not. Those that buy into it work very effectively.
Some are funded, some are not funded, but they buy into the central
goal which is "we do not want Birmingham to have people sleeping
on its streets, we do not want people dying out there, we want
to do something about it". There are, however, people who
stay outside that tent in the voluntary sector who, as Naomi said,
for all reasons want the world to be different and they must carry
on and do that and they raise their funds and do things in their
own way. The critical thing is the Government is elected, gets
a bunch of ministers, they decide they want rough sleeping sorted,
they delegate that to people like us, we then work with consortiums
who buy into that shared goal and on the whole most of the time
there are ups and downs, as always in life, partnership is not
easy, delivery is very, very hard, but we get there and hence
in my little bit of the world you have seen the numbers consistently
come down over two years.

141. In my part of the world in Staffordshire
we have got this association of drug and alcohol groups who have
come together as a county-wide unit working very, very effectively
and it looks like a model which we may be able to roll out across
the country. Do you work on similar models in your own areas,
models that can be rolled out from one area into the next one?
(Ms Casey) We certainly do in rough sleeping and some
of the drug action teams who are a bunch of people who are brought
together to try to sort something out have based their models
on the rough sleeping consortiums. There is plenty of stuff out
there to learn from but it comes back again that you can sit in
a room and have long consortium discussions until the cows come
home, but the question is will that group actually then deliver
out there on the street even in the world of drugs misuse or in
the world of rough sleeping?

142. There are key points that need to be met
to make progress. If you are not meeting those key points you
are not making progress.
(Ms Casey) Exactly.

143. You should be getting models together now
to enable you to pass them out to other groups.
(Ms Casey) We do, yes.

Mr Williams

144. I think my colleagues have covered all
of the grounds really. I think all of us as members of Parliament
having to deal with our surgeries and constituency cases get frustrated
at the number of organisations you have to write to try to get
to the bottom of one constituent's problem. We also tend to live
in a world with a democratic illusion that a minister has a magic
lever he pulls and when he pulls it things actually happen inevitably
as result of it. If we look at paragraph nine, which the Chairman
referred to, on page three, the point made there is that not all
organisations are sufficiently committed to joint working. It
uses Rough Sleepers Unit as an example, but I think that would
probably apply to most of them, "the Rough Sleepers Unit
have found in some instances when it is not providing direct funding
that it can be difficult to influence local authorities and NHS
Trusts". Is this not the reality, that at end of the day
it is a recognition of he who plays the fiddle calls the tune.
Whoever has the money is eventually going to determine what happens,
but whether that is cooperation largely depends on the income
flow of the grant flow. Is that too cynical?
(Mavis McDonald) That is rather cynical, because it
assumes that sometimes spending small amounts of money to bring
people together will not impact back on the wider behaviour of
organisations. I think both the Rough Sleepers Organisation and
Sure Start are helping, and have had some of that effect, as Louise
described. I think some of the developments at local authority
level round joint partnership, which might encompass a wider range
of activities at the sub tier level, one expects to see influencing
the behaviour of different bodies. I can quote what I think is
a reasonably good example at national level, and others might
want to join in. I think some of the work that was done round
Neighbourhood Renewal brought in health impact issues and public
health issues and brought people into an arena in which they did
not normally find themselves. One of the results of that is that
at local level in New Deal for Community areas and in local partnerships
we have found a much greater buy-in from the public Health Service
at a different kind of level. We are now going to have the public
health arm and performance measurement arm of the Health Department
and the National Health Service co-located alongside the Regional
Offices so that they can be part of strategic discussions round
the delivery programme that the regional offices are responsible
for. I think you can track through changes in thinking from small
programme beginnings.

145. I was not referring to individual programmes.
The implications of what you just said is in fact that you are
trying to recreate the old advantages of centralisation, you were
talking about the local and the central department needing to
get together, and that is referred to in paragraph 10, some of
the organisations involved in local partnerships told us were
concerned about the behaviour of central departments. How far
are you satisfied that what you are doing is going to produce
long-term changes? As Mr Gibb said, it is very difficult to quantify.
I think the NAO in its report does say it is too early as yet
to assess. We want it to work. What conviction should we have
that it is going to work in the long-term?
(Mavis McDonald) It seems to me what we have started
to get is a much clearer set of objectives in terms of what is
the desired end result across a whole range of policy and there
is much greater clarity about the interaction between the policies
than there was. They have all been addressed in a variety of ways.
If you add to that the fact that we are now very conscious of
the need to be much more aware of the actual impact of what is
going on on the ground; we are monitoring, we are trying to read
and feedback quickly what is working and what is not working,
it is running best practices, then I think one could be optimistic
in saying that we will have more success. I think I would not
be saying confidently to you I am sure we have everything in place
to ensure that happens. There are a number of issues, from accountability
to main streaming to sustaining the impetus of it over time that
you get from when you first started initiatives and how you revisit
it and re-energise it, which is something that the NAO pick up.
Things change round all of the time. The base position is not
static, other things are taking place at the same time, which
you have to look at and feed in to. If you are looking at places,
is the economy changing, and different places are facing different
impacts, you might be able to refocus and readdress some of the
issues you are handling.

146. This Committee is essentially about accountability
and if you look at page 21 it says there, "If Parliament
is not able to identify total expenditure and outcomes achieved
by the joint initiatives then Parliament cannot take assurance
that taxpayers' money has been well spent". If you then leave
that and jump to page 40 where they deal with two initiatives,
the one relating to rough sleeping and the action one relating
to childcare, again I am not interested in the question about
the individual case, I am more interested in the footnote, if
you look at footnote 1 it says, referring to the figures in Table
15, "Cost is central government expenditure only in real
terms at 2001 prices. Data on other spending directed towards
reducing rough sleeping or creating childcare places by local
authorities, voluntary agencies and businesses is not available".
Coming back to Mr Gibb's point about the nebulous of the study,
how can we know if we do not know the full cost, whether the government
is bearing a fair load, whether it is just taking on other peoples'
load or whether others are made to carry more because government
sums are going down in one programme while going up in other?
It is very difficult for an accounting Committee to judge with
that sort of information, is it not, or lack of information?
(Mavis McDonald) As Louise has already said you need
a much wider range of data before you can make a proper cost benefit
analysis and evaluation of the cost effectiveness of these kinds
of programmes. That is where I think you do need to do a full
evaluation. If you look at the report that started off rough sleeping,
you have a clear guide as to where you might be looking to find
where the potential savings are, because if you are preventing
people coming on to the streets then you are changing the position
in terms of the numbers of people who are very expensive to deal
with as individual cases. Hopefully the better your prevention
programme is the more you address the number of the kinds of problems
that led to the congruence of the growth of figures of rough sleeping
in the early 1990s.

147. Do you not perhaps feel that structural
change might make it easier rather than trying to get changes
in long-term attitudes of people who administer these programmes?
(Mavis McDonald) I think structural change might well
work in certain cases. I quoted the DWP and Job Centre Plus Agency
as one example.

148. Are you going to make any recommendations
to that effect to ministers? If you feel structural changes are
desirable do you see it as part of your job to tell ministers
that an easier way to deal with this is to alter the structure
rather than to try to alter attitudes?
(Mavis McDonald) Yes. In any studies that the SEU
do or the PIU do or we do ourselves in the Cabinet Office, if
that looked like the right answer then we would say so. I think
other departments too would make the same recommendations.

149. Who decides? We can see that most of these
are ministerial initiatives but do you have an initiating power
yourself or do you make recommendations to ministers on areas
where you think the exercise you are involved in could be of advantage?
(Mavis McDonald) Just to quote two examples that I
am most familiar with, both the Performance and Innovation Unit
and the Social Exclusion Unit work with ministers but they work
with departments in terms of analysing where they think the most
immediate requirements and needs are. Both of them work to various
oversight committees which are also capable of bringing their
own views to bear on what should be done. The strategy, as it
were, for what is looked at can be managed in the same way as
any other kind of strategic approach.

150. Oversight committees and so on, it is all
rather labyrinthine.
(Mavis McDonald) Some of them at ministerial level
I mentioned before. There is the Ministerial Committee on Social
Exclusion, for example, which sees part of its task as looking
at what the current agenda is, who is handling itnot all
work on social exclusion clearly is done within the Social Exclusion
Unitand deciding as part of that whether there are any
particular issues that are being missed. Similarly, the Chancellor
in setting up the spending review takes an overview of where in
terms of money being spent and issues being addressed he thinks
it is appropriate to recommend to his colleagues that there ought
to be a cross-cutting review and ministers also engage in steering
committees across relevant departments.

151. One area that keeps recurring with us,
whether we are dealing with the problems of the elderly or waiting
lists, for example, is the bed blocking issue. Who is responsible?
Is the NHS responsible? Is the Social Security Department responsible?
Who should move first when they are separate decision making bodies
with separate funds to break through this blocking system? Is
that something that you feel could usefully be addressed or is
it in the process of being addressed to your knowledge?
(Mr Mitchell) It is to a certain extent in the process
of being addressed. The kinds of problems that produce bed blocking
are a variety of things like the lack of availability of sufficient
professional therapists in hospitals to give older people with
broken legs the therapy they need to get out, it can be the lack
of availability of people to assess them for what is required,
it can be the lack of availability of flexible domiciliary services
for people at home or it can be the lack of residential or nursing
home places for them to go to.

152. May I say I appreciate that and I promise
you from our own analysis we are aware of that. Since there has
been an awareness of that mix of practice and mix of responsibilities
for a long time, all I want to know is is it now going to be addressed?
Is there something similar to what we have been talking about
either devised or already operating in that area?
(Mr Mitchell) It is certainly being actively addressed
because the Secretary of State for Health was recently allocated
additional funding to tackle bed blocking both in this year and
next. The Department of Health has been charged by the Chancellor
of the Exchequer in making that allocation to work out what really
are the problems to be tackled here and how can this additional
money be used to best effect to get at this problem. It has to
be said that this links to the reorganisation of the National
Health Service going on at the moment and the creation of care
trusts which are now possible where it will be possible for the
responsibilities for older people in any particular locality,
the commissioning of services for those people, to be vested in
a single organisation. That is permissive, it is not compulsory.

153. Finally, in the Cabinet Office would you
be involved in helping to develop a more integrated system in
relation to this particular problem or is this something that
would be dealt with completely by the NHS as the paymaster?
(Mavis McDonald) We could be. It is the kind of thing
where the secretariats, the people who service the Cabinet Committees
and the sub-committees, could be asked to take this issue and
go away and do an analysis of the problems of who needs to do
what to try and resolve it. It could be the sort of thing that
the PIU would be asked to do a study of if there was not work
already in hand, which as Stephen says there is, we are not sure
either of us who is leading it. It could be the kind of issue
where the Prime Minister could ask for a separate committee to
be set up to look at what was required at ministerial level.

Chairman

154. Thank you very much, Ms McDonald, for coming
to answer our questions this afternoon. This is, of course, a
nebulous subject but for all that a very important one. We hope
that you will keep Government joined up and held to account once
the political pressure has died away and you are working against
the grain of Whitehall. Thank you very much. Certainly speaking
for myself may I say that we particularly thank Louise Casey who
obviously feels passionately for her cause. It is good to have
a passionate civil servant occasionally. Thank you very much.
(Mavis McDonald) I hope you do not think that the
others of us are without passion.